The political declaration “Universal health coverage: moving together to build a healthier world” sets out a high-level framework for the development and implementation of national UHC plans with the engagement of civil society organisations and other stakeholders. The adoption of the political declaration is an important milestone for the global health community as it shows the commitment of member states to the implementation of UHC by 2030.
“Given the rising burden of cancer around the world and the devastating economic impact that cancer has on patients and their families, UICC welcomes the adoption of the Political Declaration on UHC as a key opportunity to strengthen the provision of cancer services under national essential healthcare packages.” – Sonali Johnson, Head of Knowledge, Advocacy and Policy, Union for International Cancer Control
Each country will need to prioritise and implement its own national UHC package, tailored to patient needs and taking into consideration current health system capacities. Advocacy around UHC will differ in each country but there are several paragraphs within the declaration that directly support comprehensive cancer control.
For cancer advocates, UHC planning provides an opportunity to call for alignment with existing national cancer control and NCD plans as a foundation for the priority setting process.
The declaration calls for member states to collect quality, reliable and timely data which can be disaggregated to develop policy responses to inequities in access to care and health outcomes. Cancer registries, particularly population-based cancer registries, provide a platform for such data collection.
The declaration also recognises the need and opportunity to create health-promoting environments as part of the UHC agenda. It includes commitments to prioritise immunisation, promote healthier and safer workplaces, and implement policy, legislative and regulatory measures to minimise the impact of NCD risk factors. Member States have recognised the effectiveness of fiscal measures in addressing NCD risk factors, which provides a strong advocacy foundation to call for the full implementation of the WHO ‘Best Buys and other recommended interventions’ alongside the Framework Convention on Tobacco Control (FCTC).
This table provides a quick reference to paragraphs that support key cancer control activities.
While the declaration is a key landmark for global health, certain areas of the text unfortunately remained underdeveloped.
Paragraph 27 for example, mentions access to diagnostics but it fails to recognise the importance of early detection and accurate diagnosis of diseases. For cancer, early detection represents a major opportunity to reduce cancer mortality and improve quality of life, as the early-stage disease can be treated more effectively, with fewer side effects and often at a lower cost. As such, early detection is central to the cervical cancer elimination effort as well as reducing the burden of childhood cancers, among others.
As for palliative care, the current document only identifies palliative care as a commitment in the context of care for the elderly. However, palliative care is an essential service for people throughout the life course and, for cancer patients, palliative care should start from the moment of diagnosis.
The political declaration also does not contain any time-bound commitments, which weakens the declaration overall and increases the need for advocacy nationally to ensure that governments set, communicate and monitor progress towards achieving UHC.
One of the greatest hurdles to achieving UHC is the shortfall of funding and the relative lack of investment in health. Previous drafts of the political declaration set out ambitious investment targets, including calling on high-income countries to better support health systems and a commitment for all countries to invest 5% GDP in health. However, in the final text of the declaration, this figure has been reduced to an additional 1% of GDP in health where appropriate, which is a far weaker commitment (para.43).
The adoption of the Political Declaration on UHC is only the first step. Delivering health for all by 2030 will require comprehensive national policies and concerted action by all stakeholders including advocates, patients, healthcare practitioners, healthcare planners and communities.
Given the competing health demands in each country, cancer advocates will need to take a proactive approach to champion the integration of essential cancer services in national plans and benefit packages. Here you can find some example actions that cancer advocates can take to support the integration of cancer within UHC packages in their contexts.
UICC will take the topic further at the next World Cancer Leaders’ Summit in Kazakhstan (15-17 October 2019) where approximately 350 global influencers and leaders in cancer control and public health will get together to discuss how best to scale up action towards UHC including quality cancer services.
Calling on governments to ensure the inclusion of cancer control as an integral part of their national UHC strategy and implementation plan, UICC suggests a particular focus on the need to: